Evaluation of Febrile Episodes in Children With or Without Neutropenia Undergoing Chemotherapy

OBJECTIVE: This study aims to analyze the clinical and microbiologic characteristics of febrile episodes in pediatric oncology patients undergoing chemotherapy, with and without neutropenia. PATIENTS AND METHODS: A retrospective analysis was conducted on 212 febrile episodes in 94 pediatric cancer patients hospitalized between January 2015 and December 2018. Patients with fever ≥38°C were included. Data were extracted from electronic health records. Infection diagnoses were established based on clinical examination and microbiologic studies. RESULTS: Among the 212 febrile episodes, 117 (55.1%) were classified as febrile neutropenia. Infection foci were identified in 51.4% of cases, with catheter infections being the most common (18.4%), followed by viral upper respiratory tract infections (16%). Microbiologic analysis identified bacterial agents in 69 cases. The most frequently identified bacteria were Coagulase-negative Staphylococcus and Escherichia coli. Septic shock occurred in 7 febrile episodes (3.3%), all in neutropenic patients. There was no statistically significant difference in infection rates between neutropenic and non-neutropenic groups (P>0.05), except for septic shock, which was significantly higher in neutropenic patients (P=0.02). CONCLUSIONS: Our data suggest that infections remain a major cause of morbidity in pediatric oncology patients regardless of neutropenic status. We believe that prospective and multicenter studies are also necessary to optimize infection management strategies in non-neutropenic patients with fever as well as neutropenic ones.